Esthetic Restoration of a Traumatic Fracture
A 27-year-old female with bilateral fractured maxillary central incisors wanted to make her smile whole again. For this case, we chose to restore the traumatic fracture presented to the dental office.
The esthetic restoration provided challenges in achieving an acceptable result because of the long-standing fracture of many years and the slight shifting of the teeth positions.
The esthetic appearance of the composite resin was based on shape, color, and gloss of the restoration achieved by finishing and polishing. In the case of this traumatic fracture of anterior teeth, the restoration and pulpal status were evaluated. Restoration of the fracture not only needed to address incisal length and facial contour but also the incisal, facial, and gingival embrasures to achieve an esthetic result. Shaping and finishing of the facial and lingual surfaces was very routine because of access to these surfaces.
The most difficult to access and contour surface when finishing and polishing esthetic restorations is the interproximal surface. Control of the facial embrasure and gingival interproximal surface provided challenges to maintain the proximal contact and to not notch root surfaces below the contact area. Instruments and devices used for the interproximal areas are classified as coated abrasives, typically metal or plastic strips that have abrasive particles adhesively attached to the strip. Metal strips with diamond abrasive are more universal because they can manage both composite and porcelain.
Care was taken to not aggressively finish interproximal surfaces by removing excessive composite resin or porcelain resulting in an open proximal contact. Interproximal strips were used to shape and contour the interproximal contact thus maintaining the proximal contact. In most cases, the use of a gapped finishing strips works best because they allow the operator ease of placement between the teeth.
The final esthetic restoration addressed the patient's concerns and fulfilled her expectations.